Insurance · Medical Management (WC & Health)

Compress medical cost per claim through nurse triage, network steerage, and pharmacy controls — without compromising injured-worker outcomes.

Frequently asked questions

What does the Insurance · Medical Management (WC & Health) blueprint do?

Compress medical cost per claim through nurse triage, network steerage, and pharmacy controls — without compromising injured-worker outcomes.

What KPIs does the Insurance blueprint target?

Nurse Triage at FNOL from 40 to ≥ 85 (weekly). ER Use (Eligible Cohort) from 26 to ≤ 12 (monthly). In-Network Use from 55 to ≥ 80 (monthly).

How long does the Insurance · Medical Management (WC & Health) deployment take?

12 weeks.

What systems does the Insurance blueprint integrate with?

Integrates with myMatrixx / Optum WC, Mitchell SmartAdvisor, CorVel CareMC through the AEROSS Execution Mesh. All writes are credit-metered, CAPS-gated, and audit-stamped.

What regulatory requirements does this blueprint address?

State WC fee schedules; URAC accreditation; ODG / MTUS guidelines All agent actions inherit AEROSS CAPS governance — autonomy ceilings, human approval gates, and a tamper-evident audit log.